West Virginians are at high-risk for developing coronary heart disease due to high rates of biomedical risk factors, low socio economic status, and a rural geography with limited access to health care. West Virginian's health beliefs influence participation in health care programs and must be considered in the development of interventions to improve health. The long-range goal of this research program is to prevent the development and progression of coronary heart disease in at-risk children and their parents. The objective for this application is to identify and reduce the health belief barriers to an existing cholesterol screening program in this high-risk, rural, poor population. The existing program, Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) has a four year history of providing no cost dyslipidemia testing to fifth grade children and their parents. The specific aims for this proposal are: (1) To identify health beliefs that act as barriers to participation in the dyslipidemia screening program and to develop belief-based strategies to reduce those barriers, and (2) To improve the identification of children and families who are at-risk for the development of CHD. Research Design and Methods: The Theory of Planned Behavior will provide the theoretical framework for identifying beliefs barriers and developing interventions to address them. Belief barriers to participation in the dyslipidemia detection program will be initially identified through interviews with children, parents, and community leaders in rural West Virginia. The reliability and validity of interview responses will be assessed through administration of general and study-specific health beliefs questionnaires to a larger, random sample of children and adults. A Health Beliefs (HB) approach will be developed for the screening and diagnosis phases of the dyslipidemia detection program. The new HB approach will be compared to the standard CARDIAC (SC) approach in a randomized controlled trial. Three thousand fifth grade students in fourteen counties will be randomly assigned to receive either the HB or SC approach. Participants will be followed through screening and diagnosis. The HB and SC approaches will be compared on participation rates for children and parents.